Evaluation of alternative reagents on the performance of the modified Knott's test

The aim of the present study was to evaluate the suitability of different reagents as safe alternatives to 2% formalin in the modified Knott's test for the diagnosis of subcutaneous (Dirofilaria repens) and cardiopulmonary (D. immitis) dirofilariosis. A total of 61 blood samples from dogs naturally infected with D. immitis and D. repens were collected and analysed in two different laboratories (Lab 1, University of Parma and Lab 2, University of Napoli). For each blood sample the modified Knott's method was performed to identify and measure the mean length and width of the microfilariae (mfs) using 2% formalin (A), 2% acetic acid (B), 2% glacial acetic acid (C), 10% saponin (D) and distilled water (E). When compared to 2% formalin, there was no significant difference (P > 0.05) among the mean length and width of either D. immitis or D. repens mfs with distilled water (E). The lengths and widths of mfs, however, were significantly reduced (P < 0.05) when using B, C, D likely due to more pronounced parasite dehydration. Despite differences in measurements, the morphological features of the head and tail of the two species were maintained, suggesting that all the solutions tested could be a suitable alternative to formalin. All alternative reagents caused more marked haemolysis compared to formalin, improving readability of slides. The values of the mean length and the mean width of D. immitis and the mean width of D. repens mfs obtained with formalin and distilled water were statistically different (P < 0.005) between the two laboratories. The difference in mf measurements between the two labs could be due to the use of reagents purchased from different manufacturing companies. Results suggest that distilled water could replace formalin in the modified Knott's test, as a safer reagent that allows morphology-based species differentiation of Dirofilaria spp.